Competent children? Minors’ consent to health care treatment and research

This paper concentrates on controversies about childrenʹs consent, and reviews how childrenʹs changing status as competent decision makers about healthcare and research has gradually gained greater respect. Criteria for competence have moved from age towards individual childrenʹs experience and understanding. Uncertain and shifting concepts of competence and its identification with adulthood and childhood are examined, together with levels of decision-making and models for assessing childrenʹs competence. Risks and uncertainties, methods of calculating the frequency and severity of risks, the concept of ‘therapeutic research’ and problems of expanding consent beyond its remit are considered. The paper ends by considering how strengths and limitations in childrenʹs status and capacities to consent can be mirrored in researchers’ and practitioners’ own status and capacities. Examples are drawn from empirical research studies about decision-making in healthcare and research involving children in the UK.